| Walltown Clinic | |
|
815 Broad St Durham NC 27705-4137 | |
| (919) 416-1254 | |
| (919) 416-1285 |
| Full Name | Walltown Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 815 Broad St, Durham, North Carolina |
| Authorized Official Name and Position | Claretta Foye (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9199564022 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Walltown Clinic Po Box 52119 Durham NC 27717-2119 Ph: (919) 956-4000 | Walltown Clinic 815 Broad St Durham NC 27705-4137 Ph: (919) 416-1254 |
| NPI Number | 1780631374 |
|---|---|
| Provider Enumeration Date | 05/28/2006 |
| Last Update Date | 07/28/2022 |
| Medicare PECOS PAC ID | 4587642590 |
|---|---|
| Medicare Enrollment ID | O20041101000564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780631374 | NPI | - | NPPES |
| 344500C | Medicaid | NC | |
| 344500A | Medicaid | NC | |
| 03055 | Other | NC | NC BC/BS ID NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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